Surgical Management of Giant Basilar Tip Aneurysm Associated with Moyamoya Disease: A Case Report and Literature Review.

Abstract

We report the efficacy and safety of surgical treatment with the orbitozygomatic transsylvian approach and the rarity of accompanying subarachnoid hemorrhage, Terson syndrome, and ruptured giant basilar tip aneurysm in a patient affected by moyamoya disease with a good outcome. A 40-year-old man with a history of exertional headache from childhood and hypertension diagnosed 5 years previously was referred to us with the presenting symptom of headache. After 1 day, he developed left hemiplegia, decreased level of consciousness, and blindness in the left eye. Imaging studies revealed a subarachnoid hemorrhage and giant basilar tip aneurysm. He underwent surgical clipping of the aneurysm using the orbitozygomatic transsylvian approach. With obvious improvement in strength and consciousness, the patient was discharged. Early diagnosis and treatment of the other possible complications of moyamoya disease were recommended. The rarity and different manifestations of moyamoya disease require individualized decision making with regard to cerebrovascular complications. Individualized decision making and the cooperation of medical teams are the mainstays of treatment.